{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T01:33:15Z","timestamp":1789867995810,"version":"4.0.1"},"reference-count":65,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T00:00:00Z","timestamp":1580169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32\u2010HS000032"],"award-info":[{"award-number":["T32\u2010HS000032"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG046267"],"award-info":[{"award-number":["R01AG046267"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007890","name":"University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007890","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005539","name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005539","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011082","name":"School of Medicine, University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011082","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005539","name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005539","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale, aims, and objectives<\/jats:title><jats:p>Clinical studies show equivalent health outcomes from interventional procedures and treatment with medication only for stable angina patients. However, patients may be subject to overuse or access barriers for interventional procedures and may exhibit suboptimal adherence to medications. Our objective is to evaluate whether community\u2010level health literacy is associated with treatment selection and medication adherence patterns.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The sample included Medicare fee\u2010for\u2010service beneficiaries (20% random sample) with stable angina in 2007\u20102013. We used an area\u2010level health literacy variable because of the lack of an individual measure in claims. We measured the association between (a) area\u2010based health literacy with treatment selection (medication only, percutaneous coronary intervention [PCI], or coronary artery bypass grafting (CABG) surgery) and (b) area\u2010based health literacy with medication adherence. We controlled for other factors including demographics, co\u2010morbidity burden, dual eligibility, and area deprivation index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 8300 patients of whom 8.7% lived in a low health literacy area. Overall, 56% of patients received medication only, 28% received PCI, and 15% received CABG. Patients in low health literacy areas were less likely to receive CABG (\u22123.5 percentage points; 95% CI, \u22126.8 to \u22120.3) than were patients in high health literacy areas, but the significance was sensitive to specification. Overall, 81.5% and 71.5% of patients were adherent to antianginals and statins, respectively. Living in low health literacy areas was associated with lower adherence to antianginals (\u22123.3 percentage points; 95% CI, \u22126.1 to \u22120.6) but not statins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Low area\u2010based health literacy was associated with being less likely to receive CABG and lower adherence, but the differences between low and high health literacy areas were small and sensitive to model specification. Individual factors such as dual eligibility status and race\/ethnicity had stronger associations with outcomes than had area\u2010based health literacy, suggesting that this area\u2010based measure was inadequate to account for social determinants in this study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13341","type":"journal-article","created":{"date-parts":[[2020,1,29]],"date-time":"2020-01-29T01:55:37Z","timestamp":1580262937000},"page":"1711-1721","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Treatment selection and medication adherence for stable angina: The role of area\u2010based health literacy"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3190-7740","authenticated-orcid":false,"given":"Samuel T.","family":"Savitz","sequence":"first","affiliation":[{"name":"Department of Health Policy &amp; Management, Gillings School of Global Public Health The University of North Carolina at Chapel Hill  Chapel Hill North Carolina"},{"name":"Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy Cooper","family":"Bailey","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine Northwestern University  Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie B.","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy Vanderbilt University Medical Center  Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Schuyler","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke Heart Center Duke University Medical Center  Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin G.","family":"Trogdon","sequence":"additional","affiliation":[{"name":"Department of Health Policy &amp; Management, Gillings School of Global Public Health The University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally C.","family":"Stearns","sequence":"additional","affiliation":[{"name":"Department of Health Policy &amp; Management, Gillings School of Global Public Health The University of North Carolina at Chapel Hill  Chapel Hill North Carolina"},{"name":"Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hill  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71146-6"},{"key":"e_1_2_7_3_1","volume-title":"Social Determinants of Health: The Solid Facts","author":"Wilkinson RG","year":"2003"},{"key":"e_1_2_7_4_1","volume-title":"Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health: Final Report of the Commission on Social Determinants of Health","author":"Health CoSDo","year":"2008"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.14058"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1357"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.7.1137"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20150572"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.3386\/w23002"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1300\/J134v06n03_04"},{"key":"e_1_2_7_11_1","first-page":"309","article-title":"Risk and resilience in the urban neighborhood: predictors of academic performance among low\u2010income elementary school children","author":"Shumow L","year":"1999","journal-title":"Merrill\u2010Palmer Quarterly (1982\u2010)"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2638-3"},{"key":"e_1_2_7_13_1","volume-title":"Health Literacy: a Prescription to End Confusion","author":"Kindig DA","year":"2004"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072771"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.013"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.108.798462"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.19.2411"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32714-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.916"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.7828"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2012.0019"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-10-200711200-00185"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.899211"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)91963-1"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)03694-9"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.078"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.7.767"},{"key":"e_1_2_7_28_1","unstructured":"Center for Medicare & Medicaid Innovation. Shared Decision Making Model ACO Applicant Guidance Beneficiary Fee\u2010For\u2010Service Preference\u2010Sensitive Condition Visits. In: Services CfMaM ed2015."},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.116.002641"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.3331"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-153-5-201009070-00005"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1081\/CNV-100106143"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730802592247"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2006.00691.x"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200205000-00005"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03290708"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1Q718"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028014526562"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006975"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-1105-7"},{"key":"e_1_2_7_42_1","volume-title":"Estimating and Mapping Health Literacy in the State of Missouri","author":"Lurie N","year":"2010"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"e_1_2_7_44_1","volume-title":"Area Health Resources Files","author":"Health Resources & Services Administration","year":"2017"},{"key":"e_1_2_7_45_1","unstructured":"Health Innovation Program. Area Deprivation Index. 2014;http:\/\/www.hipxchange.org\/ADI2017."},{"issue":"6","key":"e_1_2_7_46_1","first-page":"353","article-title":"Health resource utilization and direct costs associated with angina for patients with coronary artery disease in a US managed care setting","volume":"4","author":"Kempf J","year":"2011","journal-title":"American Health & Drug Benefits"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H018"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007990903126833"},{"issue":"3","key":"e_1_2_7_49_1","first-page":"27","article-title":"More accurate racial and ethnic codes for Medicare administrative data","volume":"29","author":"Eicheldinger C","year":"2008","journal-title":"Health Care Financ Rev"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.6.1761"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.2307\/1910997"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2014.11.004"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2010.0299"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2007.0224"},{"key":"e_1_2_7_57_1","article-title":"Video decision support tool for advance care planning in dementia: randomised controlled trial","volume":"338","author":"Volandes AE","year":"2009","journal-title":"BMJ (Clinical Research Ed)"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.21.2.60"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910283411806"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.059402"},{"key":"e_1_2_7_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2006.00022.x"},{"key":"e_1_2_7_62_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1989.03420020132045"},{"key":"e_1_2_7_63_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.132"},{"key":"e_1_2_7_64_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.2.202"},{"key":"e_1_2_7_65_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-10-200705150-00005"},{"key":"e_1_2_7_66_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3180616c1b"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjep.13341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.13341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.13341","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.13341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T23:26:36Z","timestamp":1693869996000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.13341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,28]]},"references-count":65,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1111\/jep.13341"],"URL":"https:\/\/doi.org\/10.1111\/jep.13341","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,28]]},"assertion":[{"value":"2019-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}